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Pharmamum’s Ultimate Guide: Vitamin D
As parents we get bombarded with a lot of advice; ‘Make sure your child receives adequate sunshine so they are getting enough Vitamin D’. ‘You need to protect your children’s skin from harmful UV rays’, ‘Ensure you ‘slip slop slap’. What advice should we follow? If we are protecting our children from the sun, how will they get enough Vitamin D? Is my child vitamin D deficient? Why is Vitamin D so important? Can’t my child obtain it from a healthy diet? I breastfeed my child, surely they are getting enough Vitamin D from me, right?
In this blog, I aim to answer the above questions, explain what this Vitamin does in our body and why is it so important? How do we balance protecting our skin from the sun whilst still allowing our bodies to synthesise enough Vitamin D. In Australia, we have the highest rates of skin cancer in the world, we need to concentrate on recommending sensible sun exposure to ensure we do not become a nation full of vitamin D deficient unhealthy people.
What is Vitamin D?
Vitamin D is a fat soluble vitamin. It is also known as a hormone which is made in the skin when we are exposed to sunlight, in particular the ultraviolet B rays. We can obtain Vitamin D three ways:
- Vitamin D supplements
We depend on sun exposure to maintain our Vitamin D levels, and the source of 90-95% of most people’s vitamin D requirement, comes from casual exposure to sunlight. Relying on food alone will not give your children the adequate amounts of vitamin D that is required. Approximately 5-10% of your daily Vitamin D requirement is obtained through food. It is found in some oily fish (eg wild salmon, sardines, tuna and in eggs). Some foods are fortified with Vitamin D eg Infant formula, margarine, some milks and yogurts. It is possible to maintain adequate vitamin D levels by taking a Vitamin D supplement.
Vitamin D deficiency is an important health issue in Australia and is common in adults and children. Vitamin D levels can be measured by a simple blood test measuring the major circulating form of vitamin D (25(OH)D). Levels below 50nmol/L is considered Vitamin D deficient. Population surveys from Australia and New Zealand have shown that 40-57% of newborns have 25(OH)D levels <50 nmol/L. We can get adequate levels of vitamin D with sensible sun exposure. You don’t need to tan or burn to get adequate levels of vitamin D. Our society, especially in Australia, has been brainwashed to think we have to stay out of the sun. In fact it’s the opposite, we need the sun shining on our skin to maintain good health and wellbeing, but we need to expose ourselves to it sensibly.
What does Vitamin D do in our bodies?
Vitamin D’s best known role is to help you develop strong and healthy bones by absorbing calcium from the diet through our intestines. If vitamin D is lacking we cannot absorb as much calcium from the diet for bone development. This leads to Rickets in children, where you see deformities in bone structure as the child grows, and in adults, osteoporosis. If this was the only role of vitamin D, that would be important enough to make sure we don’t become Vitamin D deficient. However, recent research is showing that Vitamin D can do much more. In fact, many of the body’s tissues have vitamin D receptors, and when Vitamin D binds to those receptors, it has a positive effect on those tissues. One important function Vitamin D is showing to have, is it’s role in immunity eg decreasing the risk of many chronic illnesses including common cancers, autoimmune diseases, infectious diseases and cardiovascular disease.There is also evidence that low vitamin D is linked to other health problems including, a higher risk of bowel cancer, heart disease, high blood pressure, stroke and depression. That is why we, as parents need to ensure, not only our children get enough Vitamin D, but also ourselves.
When I look at my children and think, how much sun they are exposed to during the winter months, I am concerned about their Vitamin D levels. Could they be deficient in this vitamin? I send my eldest daughter to kinder and my youngest to creche, and both have up to half an hour of play outside, once or sometimes twice a day. I dress them covered up on cold winter days in a jumper and leggings and usually when they are outside, they play with jackets on, so the only exposure to the sun is to their face and hands. On the weekends, we try to spend some time outdoors, at a park or outside playing in the garden, but again with the cold weather they are covered up. How do you know if your child is vitamin D deficient? The answer is, you don’t, unless you get a blood test and doctors won’t routinely make a child undergo a blood test simply for checking Vitamin D levels unless they have one or more risk factors for Vitamin D deficiency. They will discuss with you and assess how much sun exposure your child is receiving together with other factors eg breastfed or formula fed, skin type, environment,diet etc and from there, will recommend appropriate measures eg sensible sun exposure or a Vitamin D supplement.
Signs of vitamin D deficiency
Unfortunately, there are no obvious signs of Vitamin D deficiency. Vague symptoms of fatigue, bone pain and weakness can occur, but they can also be symptoms of other diseases. These symptoms are also impossible to be aware of in an infant. Unfortunately it’s often when the levels are extremely low, that symptoms really present ie bone deformities, delayed motor development and fractures. That is why it is important to assess your own situation and be informed about Vitamin D, how we can get it, do I need to take a supplement because my own circumstances aren’t allowing myself or my children to get adequate sun exposure. The following information will help:
So how much sun exposure do we need? The amount of sun exposure that we need will vary depending on:
- What time of the year it is, summer or winter?
- The UV level-The part of the sun’s rays that is required to make Vitamin D is UVB. On a cloudy day less UVB penetrates through the clouds, therefore your skin makes less Vitamin D.
- The time of day– Our skin produces the most amount of Vitamin D in the middle of the day
- Our skin pigmentation-People with naturally very dark skin will require 3-6 times the more sun exposure than those with fair to olive skin.
- Latitude (ie where you live), the further you are from the earth’s equator the less UVB available for your body to produce vitamin D. However, in the summer the earth rotates, and more UVB is available for your skin to produce Vitamin D.
- Age-As we get older, our skin’s ability to produce Vitamin D lessens.
In Australia, the Cancer council provides guidelines to follow, to balance the risk of skin cancer from over exposure, whilst still maintaining adequate vitamin D levels:
During summer, in the southern parts of Australia (eg Sydney, Melbourne, Canberra, Adelaide, Hobart and Perth), and all year round in northern Australia (Brisbane and Darwin), most of us need a few minutes a day of sun exposure in the mid-morning or mid-afternoon, to an area of skin equivalent to your face, arms and hands to help with vitamin D levels. Be extra cautious in the middle of the day when UV levels are most intense and temperatures are uncomfortably high.
In winter, in the southern parts of Australia, where UV radiation levels are below 3 all day, most of us need about two to three hours, spread over each week, to the face, arms and hands to help with our vitamin D levels.
In the northern parts of Australia (eg Brisbane and Darwin), UV levels are above 3 all year round, so sun protection is needed daily.
In the southern parts of the country, (eg in Adelaide, Melbourne and Hobart) the average daily UV levels remain below 3 from May to August, so sun protection is not required, unless you are at high altitudes, outside for extended periods or near highly reflective surfaces like snow.
An interesting fact is that Vitamin D is a fat soluble vitamin which means it is stored in body fat and is often released during winter when Vitamin D cannot be produced. Sensible sun exposure over the summer will allow our bodies to store vitamin D in our fat and release it in the winter when needed. The problem that we are facing, is we have become a nation that has listened to all ‘cover up in the sun messages’ that by the end of summer we are seeing vitamin D deficiencies and cannot rely on our stores to carry us through the winter.
The summer sun
- The larger the area of skin exposed to the sun, the more Vitamin D is produced in the skin. It happens very quickly (5-10 minutes) and exposing your skin for a short time will make all the vitamin D your body can produce in one day.
- Sunscreen blocks most Vitamin D production. In fact if you wear SPF 15 it blocks 99% of Vitamin D synthesis. In summer, allow your child to get their Vitamin D dose in the sun and then use appropriate measures to protect their skin. When you are at home, your children can run around in the garden for 5 minutes and then you call them in to apply sunscreen or cover up with appropriate clothing eg protective swimwear, hats etc.
- The face does not produce much Vitamin D, and is the most sun damaged. Always protect your’s and children’s face with either an appropriate sunscreen or a moisturiser with a high SPF in the summer months. Never use a sunscreen aerosol/spray, use a cream/lotion you can roll on or apply with your hands, as you do not want your children (or yourself) inhaling sunscreen particles.
- You cannot make vitamin D through glass, eg in the car if the window is up and the sun is shining through, your skin will not synthesise vitamin D through glass.
Who is at risk of vitamin D deficiency?
- People with naturally very dark skin
- People with little or no sun exposure. That includes people who avoid the sun for medical or cosmetic reasons or people who have office jobs, shift work etc
- Breast fed babies who fall into the ‘at risk’ categories and whose mother has little Vitamin D stores.
Pregnancy and breastfeeding
If there is one particular time in your life you can not afford to be vitamin D deficient, it is when you are pregnant or breastfeeding because if you do not get enough vitamin D when you are pregnant or breastfeeding, your baby’s bones can become soft. Getting enough vitamin D when you’re pregnant ensures your baby will get enough too. All pregnant women should be screened in early pregnancy and treated for vitamin D deficiency in the first trimester of each pregnancy. Both of my pregnancies were over the summer and I used to sit outside in my back garden and expose my growing belly to the sun, just for 5 minutes to make sure my vitamin D levels were adequate.
Breast milk contains little Vitamin D and breastfed babies depend solely on their mother’s Vitamin D levels. If you are breastfeeding your baby it is worth getting your vitamin D levels tested to ensure you are not deficient and passing that deficiency on to your baby. Breastfed infants of dark skinned or veiled women (with unknown vitamin D status) should be supplemented with vitamin D 400 IU per day for the first 12 months of life as there is inadequate vitamin D in their breast milk.
I am by no means recommending to put an infant in the sun, in fact it is not recommended to place an infant in direct sunlight for the first 6 months of their life, due to their delicate skin. However, if your baby is breastfed, ensure your Vitamin D levels are sufficient. If possible, try get out for walks with your newborn, enjoy the sun and fresh air, and expose your arms and legs to any available sun, for the recommended times.
If you are formula feeding- there is vitamin D fortified in all formula, so your baby’s vitamin D levels are sufficient through formula.
The most natural way to get vitamin D is exposure to the sun. Did you know, that if our bodies synthesise Vitamin D from exposure to sunlight, it stays around in the body at least twice as long as it would if you take a supplement. I personally supplement both my children and myself with Vitamin D only during the winter and after assessing how much sun we are exposed to.
In Australia, there are a few brands of Vitamin D available specifically for children. They come in liquid form, that you either squirt using a syringe directly into your child/babies mouth (Ostelin) or drop into your child/babies mouth ( Bioceuticals Vitamin D3 drops).
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.